Effective with the date of service Jan 1, 2021, the Centers for Medicare & Medicaid Services (CMS) has added new HCPCS codes (J codes), deleted others and changed the description of some existing codes. For complete information regarding all HCPCS codes and descriptions, refer to the 2021 edition of HCPSC Level II, published by Optum.
NC Medicaid and GDIT have completed system updates to align our policies with J code changes (new codes, covered and non-covered, as well as the end-dated codes) to ensure that claims billed with the new codes will process and pay correctly.
Claims submitted with deleted codes will be denied for dates of service on or after Dec. 31, 2020. Previous policy restrictions continue in effect unless otherwise noted. This includes restrictions that may be on a deleted code that are continued with the replacement code(s).
|
New HCPCS code covered (effective Jan. 1, 2021) |
Description |
Brand Name |
NDC |
Old HCPCS code (Ineffective Dec. 31, 2020) |
|
J0693 |
Injection, cefiderocol, 5 mg |
Fetroja |
59630-0266-01 59630-0266-10 |
J3490 |
|
J1823 |
Injection, inebilizumab-cdon, 1 mg |
Uplinza |
72677-0551-01 |
J3590 |
|
J9144 |
Injection, daratumumab, 10 mg and hyaluronidase-fihj |
Darzalex Faspro |
57894-0503-01 |
J9999 |
|
J9223 |
Injection, lurbinectedin, 0.1 mg |
Zepzelca |
68727-0712-01 |
J9999 |
|
J9281 |
Mitomycin pyelocalyceal instillation, 1 mg |
Jelmyto |
72493-0101-40 72493-0103-03 |
J9999 |
|
J9316 |
Injection, pertuzumab, trastuzumab, and hyaluronidase-zzxf, per 10 mg |
Phesgo |
50242-0245-01 50242-0260-01 |
J9999 |
|
J9317 |
Injection, sacituzumab govitecan-hziy, 2.5 mg |
Trodelvy |
55135-0132-01 |
J9999 |
|
S0013 |
Esketamine, nasal spray, 1 mg |
Spravato |
50458-0028-00 50458-0028-02 50458-0028-03 |
J3490 |
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